Government accused of risk register cover-up

The government has been accused of an ‘epic cover-up’ after defying a second court order to reveal the contents of the risk register, which analyses the dangers involved in the Health and Social Care Act reforms.

Pharma Times describes the decision by Health Secretary Andrew Lansley to defy the provisions of the Freedom of Information Act as ‘unusual’. It quotes shadow health secretary Andy Burnham as saying it was a ‘disgraceful decision’ and ‘a cover-up of epic proportions’.

But in a statement this week, the DH insisted that ministers and officials should be able to carry out sensitive policy formulation without the fear that it would later be published. It added that regular disclosure would skew the form and content of deliberations by preventing frank and open discussion.

A campaign for publication has been going on for 18 months, based on the argument that the public have the right to know what risks the reforms pose to the health services they pay for and rely on. Courts have twice found in favour of disclosure. A draft version of the document has already been leaked and widely publicised.

The Information Commissioner’s Office will now review Mr Lansley’s decision. The BBC reports a spokesman as saying: ‘We will need to study the secretary of state’s statement of reasons for imposing the ministerial veto in this case. These must, under the criteria established by the government, be ‘exceptional’. We will present the commissioner’s formal report on the matter to Parliament next week.’

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Savings from IT – lessons from NZ and GPs

New Zealand reckons the NHS should follow its example in the use of healthcare IT – while a UK GP claims he knows how to save £20 a patient.

HSJ (subscription required) carries an interview with Chai Chuah, director of New Zealand’s national health board business unit, who discusses how IT has boosted efficiency and cut spending. Like the UK, the country faced major financial problems and demanded that its 20 district health boards took drastic action to cut their deficits. The country has a five-year national health IT plan with annual priorities.

Mr Chuah said key projects included a move to greater sharing of information between GPs and hospitals. These included ‘shared care plans’ in Auckland, the country’s largest city, with an IT system that allows GPs, patients, specialists and other healthcare professionals to access, update and share information.

New Zealand has also pioneered the involvement of patients at an early stage of IT programmes, helping to avoid concerns about privacy.

Meanwhile Pulse reveals that giving patients online access to their care records can be a serious money-saver. Dr Amir Hannan explains how his practice has saved £20 per patient by providing access to records and self-care advice on its website.

NHS Somerset is planning its own remote care project with a telehealth scheme to monitor the symptoms of 4,000 people with long-term conditions over the next three years, using technology from Safe Patient Systems.

EHI says it will be one of the largest roll-outs of telehealth monitoring outside the national whole system demonstrator project, and will focus on people with chronic obstructive pulmonary disease, congestive heart disease and diabetes.

The Safe Mobile Care System was developed by consultant surgeon David Morgan, and provides patients with a touch-screen mobile phone-style device, which is programmed with personalised care plans.

Health service failing on multimorbidity

The NHS is coping poorly with the rising number of under-65’s with chronic and complex conditions. New research, analysing 1.75m people in Scotland, showed that a quarter have two or more conditions. The BBC and GP online report that their care was poorly organised and co-ordinated.

The study, published in the Lancet, recommends radical change and a more personalised approach to care. Among its findings was that multimorbidity occurs 10-15 years earlier in people living in deprived areas. The result is that the poorest sections of society are more likely to have a combination of illnesses (physical and mental) ranging from COPD, diabetes and cancer to stroke and depression.

One problem is that current approaches tend to focus on a single issue, rather than the multimorbidity itself. Care is fragmented because patients see a variety of specialists whose efforts are not co-ordinated.

Graham Watt, professor of general practice at Glasgow University, said: ‘Any country with an ageing population is heading in this direction. The status quo isn’t an option because it leads in the wrong direction.’

In an opinion piece for Guardian Healthcare, Neelie Kroes, vice-president of the European Commission argues that the way ahead for all patients is through the greater use of telemonitoring, electronic prescriptions, and applications that help prevent people from needing acute care and allow them to live in their homes.

‘I would love to make healthcare less intrusive and more personalised, as well as more affordable. The way to do that is to design care around patients, and the means of achieving that is better integration of digital technology into the caring processes. That is worth fighting for, even if there are stumbles along the way.’

Child care record plans plus new moves on social care

The government has no plans for a single IT system to deliver its newly published proposals for child health information systems. The document instead concentrates on setting standards and describing requirements. This leaves the market open to different suppliers to compete for local contracts.

EHI reports that England currently has around 99 child health information systems with a range of suppliers and system types involving at least 17 external suppliers of which the top three suppliers have installed 55% of the systems in place.

The report, from the DH’s Child Health Information Systems Transition Steering Group, sets out functionality requirements for all elements of child health systems. It says the requirements are based on a consensus across professional bodies as well as national standards, statutory requirements and information sharing rules.

It envisages a shared record system able to exchange data with other systems, allowing access by multiple professionals. It would produce a summary report of individual children, meaning information would only have to be recorded once and allow parents, carers and young people to access their health records online.

Further change is on the way in social care, with the Queen’s Speech including a draft bill on overhauling care and support for elderly and disabled people in England.

The BBC says that the news received a lukewarm welcome from charities concerned about the unaffordability of proper care for many people. The director general of Age UK, Michelle Mitchell, said: ‘This means no legislation for at least a year to drive the reform of social care law and funding that we desperately need.’

Ministers say the bill will put people in control of their care and give them choice.

News in brief

  • Citadel Events to join forces with HIMSS: British Journal of Healthcare Computing reports that Citadel Events has formalised its strategic alliance with HIMSS having worked closely together at HEALTH+IN4MATICS 2012. HIMSS has taken a financial share in the privately owned, event-organising company, strengthening the expansion plans of both organisations within the healthcare IT market.
  • £30m Portuguese Record System: Brighton and Sussex hospitals are investing £30m for a full EPR from Portuguese firm Alert Life Sciences. EHI says it will cover everything from urgent care to care planning, decision support and integration.
  • Welsh NHS needs radical change: The Welsh NHS Confederation has called for the centralisation of many services to avoid potential collapse. A complete change of focus is also recommended to catch illnesses earlier and avoid hospital admissions.
  • 1,000 iPads for Bradford: Bradford Teaching Hospitals could give its clinicians up to 1,000 iPads for accessing electronic patient records. The Guardian says the contract with Kainos Evolve is expected to bring swifter data sharing and access.
  • Trial favours cheaper eye drug: The NHS-funded IVAN clinical trials, involving 610 patients in 23 hospitals, found that savings of £84m can be made on the treatment of wet age-related macular degeneration – a leading cause of blindness. Avastin, costing £60 an injection was shown to be as effective as Lucentis, at £700.


Dr Andrew Litt, Dell’s chief medical officer sets out his vision for the future of healthcare IT in Computing magazine. His call is to start local, and with clinical needs as the priority – adding that the technology is the ‘easy’ bit. In this way he believes that the world can save billions on health, sharing best-practice internationally.

‘We must connect disparate healthcare data sources to simplify information exchange and enable the kind of analytics that helps hospitals identify and replicate best care practices…

‘[We must] tap the digital data generated by electronic medical records, imaging and genomic research for intelligence that will lead to major innovations.

‘High-performance computing is making genomic information more accessible to physicians and researchers by collapsing the cost of gene sequencing — from millions of dollars per genome a decade ago to a few thousand dollars today. Once armed with integrated electronic medical record systems that include genomic information, physicians can develop more-targeted therapies and lifetime wellness plans for patients with genetic predispositions to specific diseases.

‘Now is the time to embrace the strategies and computing models that will help us turn an information deficit into an information dividend. Once individual countries have closed the gap, we can band together to bring every society to the health standard of the highest.’

Highland Marketing blog

Mark Venables compares the health IT events of the last two weeks and offers his predictions on what might happen next year.

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